Review article
Axillary Treatment in Breast Cancer Surgery: Systematic Review of Its Impact on Survival
Estado actual del tratamiento de la axila en la cirugía primaria del cáncer de mama: revisión sistemática de su impacto en la supervivencia
Alejandra García Novoa
, Benigno Acea Nebril
Corresponding author
Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain
Read
4414
Timeswas read the article
740
Total PDF
3674
Total HTML
Share statistics
array:24 [ "pii" => "S217350771730193X" "issn" => "21735077" "doi" => "10.1016/j.cireng.2017.08.002" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1804" "copyright" => "AEC" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Cir Esp. 2017;95:503-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 860 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 686 "PDF" => 173 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0009739X1730180X" "issn" => "0009739X" "doi" => "10.1016/j.ciresp.2017.08.004" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1804" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Cir Esp. 2017;95:503-12" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3451 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 2776 "PDF" => 670 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión de conjunto</span>" "titulo" => "Estado actual del tratamiento de la axila en la cirugía primaria del cáncer de mama: Revisión sistemática de su impacto en la supervivencia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "503" "paginaFinal" => "512" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Treatment of the axila in breast cancer surgery: Systematic review of its impact on survival" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2050 "Ancho" => 2184 "Tamanyo" => 187811 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo para la selección de los estudios incluidos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandra García Novoa, Benigno Acea Nebril" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Alejandra" "apellidos" => "García Novoa" ] 1 => array:2 [ "nombre" => "Benigno" "apellidos" => "Acea Nebril" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S217350771730193X" "doi" => "10.1016/j.cireng.2017.08.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217350771730193X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X1730180X?idApp=UINPBA00004N" "url" => "/0009739X/0000009500000009/v1_201711081152/S0009739X1730180X/v1_201711081152/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173507717301904" "issn" => "21735077" "doi" => "10.1016/j.cireng.2017.05.012" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1772" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Cir Esp. 2017;95:513-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1816 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 1582 "PDF" => 233 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Pancreas Transplantation: Advantages of a Retroperitoneal Graft Position" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "513" "paginaFinal" => "520" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante de páncreas: ventajas de la posición retroperitoneal del injerto" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1212 "Ancho" => 1735 "Tamanyo" => 284653 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">(a) Pancreas transplantation with enteric drainage of the exocrine secretions to the native duodenum, systemic venous drainage and arterial reconstruction of the pancreas using a Y arterial graft; (b) pancreas transplantation with enteric drainage of the exocrine secretions to the native duodenum, systemic venous drainage and arterial reconstruction of the pancreas using end-to-end splenomesenteric anastomosis. The diagram shows the arterial anastomosis of the graft to the aorta. In our series, the anastomosis was done to the right primitive iliac artery.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Joana Ferrer, Víctor Molina, Ramón Rull, Miguel Ángel López-Boado, Santiago Sánchez, Rocío García, Ma José Ricart, Pedro Ventura-Aguiar, Ángeles García-Criado, Enric Esmatjes, Josep Fuster, Juan Carlos Garcia-Valdecasas" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Joana" "apellidos" => "Ferrer" ] 1 => array:2 [ "nombre" => "Víctor" "apellidos" => "Molina" ] 2 => array:2 [ "nombre" => "Ramón" "apellidos" => "Rull" ] 3 => array:2 [ "nombre" => "Miguel Ángel" "apellidos" => "López-Boado" ] 4 => array:2 [ "nombre" => "Santiago" "apellidos" => "Sánchez" ] 5 => array:2 [ "nombre" => "Rocío" "apellidos" => "García" ] 6 => array:2 [ "nombre" => "Ma José" "apellidos" => "Ricart" ] 7 => array:2 [ "nombre" => "Pedro" "apellidos" => "Ventura-Aguiar" ] 8 => array:2 [ "nombre" => "Ángeles" "apellidos" => "García-Criado" ] 9 => array:2 [ "nombre" => "Enric" "apellidos" => "Esmatjes" ] 10 => array:2 [ "nombre" => "Josep" "apellidos" => "Fuster" ] 11 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Garcia-Valdecasas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X17301343" "doi" => "10.1016/j.ciresp.2017.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X17301343?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507717301904?idApp=UINPBA00004N" "url" => "/21735077/0000009500000009/v1_201712020521/S2173507717301904/v1_201712020521/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173507717301953" "issn" => "21735077" "doi" => "10.1016/j.cireng.2017.11.003" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1815" "copyright" => "AEC" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Cir Esp. 2017;95:490-502" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3440 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 2833 "PDF" => 606 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Prevention of Surgical Site Infection: Analysis and Narrative Review of Clinical Practice Guidelines" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "490" "paginaFinal" => "502" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevención de la infección de sitio quirúrgico: análisis y revisión narrativa de las guías de práctica clínica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1799 "Ancho" => 3012 "Tamanyo" => 435159 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Search strategy and document management flow diagram.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Javier Gómez-Romero, Maria Fernández-Prada, Juan Francisco Navarro-Gracia" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Gómez-Romero" ] 1 => array:2 [ "nombre" => "Maria" "apellidos" => "Fernández-Prada" ] 2 => array:2 [ "nombre" => "Juan Francisco" "apellidos" => "Navarro-Gracia" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X17302075" "doi" => "10.1016/j.ciresp.2017.09.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X17302075?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507717301953?idApp=UINPBA00004N" "url" => "/21735077/0000009500000009/v1_201712020521/S2173507717301953/v1_201712020521/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Axillary Treatment in Breast Cancer Surgery: Systematic Review of Its Impact on Survival" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "503" "paginaFinal" => "512" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alejandra García Novoa, Benigno Acea Nebril" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Alejandra" "apellidos" => "García Novoa" "email" => array:1 [ 0 => "maria.alejandra.garcia.novoa@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Benigno" "apellidos" => "Acea Nebril" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estado actual del tratamiento de la axila en la cirugía primaria del cáncer de mama: revisión sistemática de su impacto en la supervivencia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2050 "Ancho" => 2196 "Tamanyo" => 174813 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Flowchart for the selection of the studies included.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years, we have witnessed a change in decision-making for adjuvant treatment in women with breast cancer. Previously, disease staging based on tumor size and lymph node involvement were the elements that determined the choice of locoregional and systemic treatment. Currently, biological factors of the tumor are the basis for the selection of systemic treatment, and the choice of drugs is almost exclusively defined by the immunohistochemical or genetic characteristics of the tumor.<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">1–4</span></a> On the other hand, the decision of axillary treatment has not experienced this evolution and, consequently, axillary staging continues to be the key factor for the indication of axillary lymph node dissection (ALND) or axillary radiotherapy (ART). At present, this decision is controversial, for different reasons. The first, old clinical trials (CT)<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">5–10</span></a> with selected groups of patients have indicated that axillary treatment does not have an impact on overall survival (OS). Secondly, other trials<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">11–13</span></a> show that ALND can be suppressed in a select group of women with micrometastatic involvement of the sentinel lymph node (SLN), without compromising disease-free survival (DFS) or OS. Finally, some CT<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">14,15</span></a> have demonstrated the non-inferiority of ART versus ALND in women with metastatic SLN, with a lower incidence of lymphedema. These facts have resulted in modifications in axillary treatment strategy in women with N1 (1–3 lymph nodes) involvement.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of this study is to develop a systematic review in order to analyze the impact of axillary treatment (ALND, ART) in primary surgery for breast cancer, with the aim to establish clinical recommendations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Method</span><p id="par0015" class="elsevierStylePara elsevierViewall">A bibliographic search was carried out in PubMed, the Cochrane Library and Academic Google with the search terms: “axillary lymph node dissection”, “axillary radiotherapy” and “micrometastasis”, in association with the words “breast cancer”. The search was formulated according to the PICOS strategy where P was: women with breast cancer and primary surgery; I: axillary lymphadenectomy; C: ART or follow-up; O: OS and morbidity; S: clinical trials and meta-analyses. The PRISMA<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">16</span></a> methodology was used. A search of clinical trials presently underway was also done on <a href="http://www.clinicaltrials.gov/">www.clinicaltrials.gov</a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Inclusion and exclusion criteria: included in the study were CT that have analyzed OS with a mean follow-up of at least 5 years, as well as quality meta-analyses that comparing axillary treatments published between 1980 and 2017 in Spanish or English. The study population was comprised of women with primary surgery for their illness (Tis-T4a, N0–N3, M0). Finally, this review included CT that are currently underway and are analyzing the impact of axillary treatment on survival, with the aim to discuss lines of future research. Excluded from the study were duplicate studies, those published in other languages and those that, due to their methodology, follow-up time or number of patients included, were not considered relevant. Similarly excluded were those CT and meta-analyses that either did not report OS or included patients with neoadjuvant chemotherapy or metastatic breast cancer (stage IV).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two reviewers (BA and AGN) examined the titles and abstracts of the references uncovered in the search to identify potentially eligible publications. The full text of the selected articles was obtained after reading the title/summary, and the selection criteria were applied to review each trial. The 2 reviewers independently evaluated each of the trials that were potentially eligible for inclusion in the review, and discrepancies were resolved by discussion. By mutual agreement, those of greatest importance were chosen. The selected CT and meta-analyses analyzed axillary treatment in primary breast cancer surgery. Finally, a critical analysis was carried out to establish recommendations for clinical practice. The level of evidence and recommendation grades were established according to criteria of the US Preventive Service Task Force.<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 6891 articles were potentially eligible, and 359 of these were duplications. After reading the title or the abstract, we excluded 5873 studies as they were not related with the subject and 535 for the following reasons: 35 for being retrospective, 108 for being observational studies; 335 for opinion or with incorrect methodology; and 57 for being published before 1980. A total of 23 CT and 12 meta-analyses were included in the systematic review (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The search identified 13 CT in progress that studied axillary treatment in different clinical settings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Axillary Lymph Node Dissection in Patients Without Lymph Node Involvement (N0)</span><p id="par0035" class="elsevierStylePara elsevierViewall">Our bibliographic search identified 7 CT that analyzed the impact of ALND in the OS of patients with no clinical axillary involvement (cN0) prior to the introduction of sentinel lymph node biopsy (SLNB).<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">6,18,19</span></a> Four of them<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">9,10,18,19</span></a> compared ALND with the follow-up and did not show significant differences in the OS of both groups after a mean follow-up of at least 5 years. However, 2 of these CT<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">9,10</span></a> only included elderly patients. Another 2 CT compared ALND versus ART.<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">6–8</span></a> One of them, by Cabanes et al.,<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">7</span></a> reported a significant benefit of ALND; however, this benefit disappeared in the long-term follow-up (180 months). Finally, the NSABP B-04 study randomized patients with mastectomy for ALND, ART and follow-up, with no evidence of benefits in DFS or OS in patients with clinically negative axillary nodes (cN0) without ALND (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Three EC,<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">20–22</span></a> that included more than 7000 patients, have compared SLNB to ALND in patients without pathological involvement of the axilla (pN0) and have showed a similar incidence of axillary recurrence and OS, with less morbidity in patients with SLNB (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Three meta-analyses compiled the results of these studies.<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">23–25</span></a> The meta-analysis by Sanghani et al.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">23</span></a> and Rao et al.<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">24</span></a> demonstrated no benefits of ALND in the OS of patients without clinical involvement of the axilla (cN0). In contrast, the meta-analysis by Orr<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">25</span></a> described a 5% benefit in the survival of women with ALND. However, this study presents 2 limitations: first, few patients with T1a tumors are included and, consequently, the extrapolation of these results may be inadequate, as a large number of patients had non-palpable tumors. Secondly, no patient received adjuvant chemotherapy, which could influence the reduction of risk evidenced in the meta-analysis (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Finally, the Cochrane review from 2017<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">26</span></a> showed similar OS in patients treated with SLNB and those with ALND.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Axillary Lymph Node Dissection in Patients With Sentinel Lymph Node Involvement</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Micrometastasis (pN1mic)</span>: Two CT<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">11,12</span></a> compared ALND to observation in patients with micrometastatic involvement of the axilla in breast-conserving surgery and mastectomy. In both CT, the average 5-year follow-up did not show significant differences in DFS or OS between both groups, so the authors concluded that ALND can be omitted in women with micrometastatic involvement of the SLN (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Macrometastasis (pN1)</span>: The ACOSOG-Z0011<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">13</span></a> trial is the only one that specifically analyzes the benefit of ALND in women with macrometastasis of the SLN. This study included women with up to 2 metastatic SLN (44.8% with micrometastasis) who underwent breast-conserving surgery and radiotherapy and were randomized to follow-up or ALND. With a mean follow-up of 9.25 years,<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">27</span></a> the updated data of this CT show a similar incidence of axillary recurrence (SLNB: 1.5% and ALND: 0.5%) and OS in both groups, with no differences in regional recurrence between patients with radiotherapy of the 3 lymph node levels and those who only received tangential fields. The authors conclude that, in a group of women with early-stage breast cancer and SLN involvement, ALND can be omitted (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Some authors have indicated that this study presents certain limitations, among them the early finalization of the study (891 patients instead of the intended 1900), the majority of patients with luminal tumors (80%), no immunohistochemical study of the SLN and, in particular, the omission of the description of the lymph node radiotherapy fields. This last factor led the authors of the ACOSOG-Z0011<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">13</span></a> to review the planning of the radiotherapy fields used in the patients included in the study. In 2014, the authors published an article analyzing radiotherapy fields and found that 81.1% of patients only received breast radiation therapy and that there were no differences in the incidence of regional recurrence between patients with or without ART.<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">28</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Six meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">29–34</span></a> have analyzed the impact of ALND in women with SLN metastasis (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Five of them<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">29–33</span></a> determined that, in patients with clinically negative axillae and micrometastatic involvement of the SLN (pN1mic), suppression of ALND permits adequate local control without compromising OS. In contrast, the meta-analysis by Joyce et al.<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">34</span></a> showed evidence of the benefit of ALND in terms of axillary recurrence and OS.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Axillary Radiotherapy in Patients With Lymph Node Involvement (N1–N3)</span><p id="par0065" class="elsevierStylePara elsevierViewall">Two CT, the DBCG 82<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">35</span></a> and the Ragaz et al. trial,<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">36,37</span></a> analyze the impact of ART in the survival of patients with breast cancer (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Both found a significant decrease in locoregional recurrences and distant metastases, which is seen in an increase in long-term OS in patients with metastasis in 4 or more lymph nodes and regional radiotherapy. The CT by Ragaz<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">36,37</span></a> found the same benefit for patients with involvement of between 1 and 3 lymph nodes.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Two meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">38,39</span></a> have analyzed the impact of lymph node radiotherapy in patients with axillary involvement. The study by McGale et al.,<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">38</span></a> which includes 22 randomized CT, showed evident benefits in locoregional control and OS for 15 years in patients with axillary involvement (N1, N2, and N3) and associated radiotherapy after mastectomy. The meta-analysis by Headon et al.<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">39</span></a> evaluated lymph node radiation therapy in patients with N1 involvement and mastectomy and showed decreased risk of locoregional recurrence, with a minimum impact on OS (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Axillary Radiotherapy in Patients Without Clinical Lymph Node Involvement (cN0)</span><p id="par0075" class="elsevierStylePara elsevierViewall">Two studies<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">5,40</span></a> analyze the effect of ART without clinical involvement of the axilla (cN0). The first of them, the NSABP B-04,<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">5</span></a> did not show differences in the OS of women with or without axillary treatment. The study by Zurrida et al.<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">40</span></a> included 435 women with T1 tumors and clinically negative axillae (cN0), no axillary surgery (no ALND or SLNB), randomized to follow-up or ART and only showed a slight increase in axillary recurrence in the group with no axillary treatment (1 vs 0.5%) and no impact on survival (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Likewise, the meta-analysis by McGale et al.<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">38</span></a> did not find any benefits of axillary radiation therapy in N0 patients.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Axillary Radiation Therapy as an Alternative to Axillary Lymph Node Dissection in Patients With Metastatic Sentinel Lymph Node</span><p id="par0080" class="elsevierStylePara elsevierViewall">Two CT, the AMAROS<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">14</span></a> and OTOASOR,<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">15</span></a> have analyzed the impact of ART as an alternative to ALND in N1 patients (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Both CT studied the non-inferiority of lymph node radiation therapy versus ALND in patients with clinically negative axillae and metastatic involvement of the SLN. No significant differences were found in the axillary recurrences or in the 5-year OS between the two groups, with a lower rate of lymphedemas in women without ALND. The authors concluded that lymph node radiotherapy is a valid alternative to ALND in these patients.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The results of these 2 CT<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">14,15</span></a> were included in the meta-analyses by Zhang et al.<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">41</span></a> and Schmidt-Hansen et al.,<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">32</span></a> showing similar DFS and OS in pN1 patients treated with ART and without ALND (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Internal Mammary Chain Radiotherapy</span><p id="par0090" class="elsevierStylePara elsevierViewall">Three CT<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">42–44</span></a> have evaluated the efficacy of internal mammary chain radiation (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The MA.20<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">42</span></a> included patients with breast-conserving surgery, with N1 axillary involvement or no lymph node involvement and risk factors for local recurrence, who were randomized to lymph node radiotherapy (including the internal mammary chain) or follow-up. All patients with lymph node involvement underwent ALND. No significant differences were observed in OS after 10 years between the two groups, but there was a decrease in the rate of disease recurrence. The second of the CT, by Poortmans et al.,<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">43</span></a> included more than 4000 patients with central or medial breast tumors in stages I, II or III, with ALND in cases of lymph node involvement, and analyzed the impact of radiotherapy on the internal mammary chain. The results of the study did not show differences in OS, although a decrease was observed in locoregional recurrences and distant metastasis in the irradiated group. Both studies concluded that the individualized selection of the therapeutic regimen is the key to improved survival. The multicenter CT by Hennequin et al.<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">44</span></a> randomized patients with lymph node involvement (N1–N3) or medial tumors to radiation or no radiation of the internal mammary chain. After 10 years of follow-up, the authors found no benefit in the local control of the disease or OS.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The meta-analysis by Budach et al.<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">45</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), which included these 3 CT, concluded that the irradiation of the internal mammary chain generates a certain benefit in OS, although after 10 years this benefit is minimal (1 vs 3.3%).</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Several CT have shown a risk of axillary recurrence between 19 and 37% in clinically negative axillae that do not receive treatment (no ALND or radiation therapy), which can be reduced to 0%–3.5% with either ALND or ART.<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">46–49</span></a> These results show the importance of axillary evaluation, using either ultrasound or SLNB, to identify women with lymph node involvement but no clinical evidence who would benefit from axillary treatment. However, the trials completed prior to the introduction of SLNB<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">5–10</span></a> showed no differences in the survival of patients with clinically negative axillae treated with ALND, ART or follow-up. The same is true for the meta-analyses<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">23,24</span></a> that included these studies, in spite of residual axillary disease ranging from 21 to 40%. These CT<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">5–10</span></a> are old, so their results are not presently applicable. Subsequently, the introduction of the SLNB technique has demonstrated the safety of suppressing ALND in patients with no metastatic involvement of the SLN. This staging method of stability does not compromise DFS or OS, in spite of 10% false negatives, and the morbidity rate is lower. These studies constitute the scientific basis for not treating the axilla (no ALND or ART) in women without metastatic involvement of the SLN (pN0) and this recommendation is collected in international clinical guidelines<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">2,3,50</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Currently, 4 CT in progress are evaluating the need for SLNB in patients with clinically negative axillae at diagnosis and will compare axillary staging by ultrasound versus SLNB.<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">51–54</span></a> The results will be published between 2017 and 2027 (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Various studies<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">55–60</span></a> have analyzed the clinical relevance of the micrometastatic involvement of the SLN and the need for ALND. Mittendorf et al.<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">60</span></a> did not show differences in OS or DFS among patients with stage IA (pN0) and IB (pN1mi) breast cancer. Instead, the biological characteristics of the tumor, such as hormone receptors and tumor grade, were related to survival. In the same way, Giuliano et al.<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">61</span></a> did not detect either a decrease in survival in those women with micrometastasis of the SLN detected by immunohistochemistry. The results of 3 CT (IBCSG 23-01,<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">11</span></a> ATTRM<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">12</span></a> and ACOSOG-Z0011<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">13</span></a>), as well as various meta-analyses,<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">29–33</span></a> recommend observation without ALND in patients with micrometastatic involvement of the SLN, either in conservative surgery or in mastectomy. Only one of the meta-analyses<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">34</span></a> included in this review demonstrated ALND to be beneficial in this group of patients. However, this meta-analysis includes methodologically disparate CT comparing ALND with ART prior to the introduction of the SLNB and SLNB validation studies. Currently, American and European clinical guides<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">1,50</span></a> recommend omitting axillary treatment (no ALND or ART) in patients with SLN micrometastasis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The SENOMIC<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">62</span></a> trial, whose results should be published this year, will show more evidence about the impact of suppressing ALND in patients with SLN micrometastasis and breast-conserving surgery or mastectomy (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><p id="par0110" class="elsevierStylePara elsevierViewall">Patients with macrometastatic involvement of the axilla limited to 1–3 lymph nodes are currently the most controversial groups for axillary treatment. The main difficulty for a recommendation in these patients is their heterogeneity, since there are patients with 1–3 lymph nodes, with and without extracapsular involvement, tumors with adverse tumor biology and breast-conserving surgery or mastectomy. This variety of patients has not been adequately categorized in the CT and, for this reason, we lack a criterion that would allow us to identify which N1 patients are at high risk for axillary recurrence. The ACOSOG-Z0011<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">13</span></a> study included a sample of patients with predominance of luminal tumors, a large percentage of them only with micrometastasis, and it seems to indicate that in this group of patients the omission of ALND is safe in breast-conserving surgery. Other authors<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">14,15</span></a> propose replacing ALND with ART in patients without clinical axillary involvement with SLN metastasis. However, both trials (AMAROS<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">14</span></a> and OTOASOR<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">15</span></a>) did not include a control group without axillary treatment, which forces one to question the need for radiating the 3 axillary levels and supraclavicular area in all patients with metastatic SLN without ALND. An observational study of our center<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">63</span></a> proposes treatment with ART in patients with macrometastatic SLN involvement without ALND who present other risk factors for regional recurrence (triple-negative tumors or HER2, lymphovascular invasion, high tumor grade, etc.). However, this study presents all the limitations of not being a randomized CT and its conclusions do not establish recommendations.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Therefore, there is presently not enough evidence to suppress the axillary treatment in these patients, but there also is no evidence to support the systematic indication of ALND or ART. The future of this discussion should be oriented toward the introduction of biological criteria in the decision-making process of axillary treatment, such as that done with gene platforms for the indication of systemic treatment. While awaiting this possibility, Huang et al.<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">33</span></a> recommend including patient preference in the final decision. Currently, 3 CT<a class="elsevierStyleCrossRefs" href="#bib0660"><span class="elsevierStyleSup">64–66</span></a> are under way that will study the impact of ALND versus follow-up in patients with macrometastatic involvement of the SLN. Another 2 CT<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">67,68</span></a> will analyze the impact of ART. The OPTIMAL<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">67</span></a> trial includes patients with metastatic involvement of the SLN without ALND and randomizes them to ART or follow-up. The POSNOC<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">68</span></a> assay includes patients with metastatic SLN involvement and randomizes them for observation, ALND or ART. The results of these trials will be available between 2022 and 2027 (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). Until these studies are published, and based on the previously raised premises, it seems necessary for each case to be individualized by a multidisciplinary committee, in which the patient's opinion could be incorporated. We propose suppressing axillary treatment (no ALND or ART) in women with low risk for locoregional recurrence and recommend ART in patients with risk factors for locoregional recurrence.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally, 2 CT<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">35–37</span></a> justify the association of ALND and ART in patients with metastasis in 4 or more axillary lymph nodes. Although these trials are old and patients did not receive specific systemic treatments (antibodies), clinical guidelines based on these studies recommend ALND and lymph node radiotherapy (axillary and supraclavicular) in patients with N2–N3 lymph node involvement (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). On the contrary, although the irradiation of the internal mammary chain decreases the risk of local relapse, it has not shown a benefit in OS.<a class="elsevierStyleCrossRefs" href="#bib0550"><span class="elsevierStyleSup">42–44</span></a> Therefore, the internal mammary chain should not be included in the radiotherapy fields (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><p id="par0125" class="elsevierStylePara elsevierViewall">This review presents several limitations. First, the oldest studies included patients with less effective adjuvant treatment compared to the most recent trials. This is especially important in the risk for locoregional recurrence of HER2 tumors without biological therapy. Second, many studies do not contemplate the categorization of risk factors for recurrence and the biological characteristics of the disease, which prevents estimating the effect of the treatments. Finally, the lack of statistical analysis of our review does not allow the impact of the proposed recommendations to be established.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion, this systematic review establishes the suppression of axillary treatment in women with breast cancer without pathological lymph node involvement (pN0) or with micrometastatic involvement of the SLN, since they do not benefit from axillary treatment (no ART nor ALND). In contrast, patients with extensive axillary disease (N2 and N3) benefit from ALND and ART to improve their OS and DFS. Patients with macrometastatic axillary disease (pN1) constitute a heterogeneous group that requires individualized analysis of risk factors to determine optimal axillary treatment. The recommendations in this group of patients will be defined by clinical trials that are currently underway, whose results will become available in the next decade.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of Interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">There are no conflicts of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres949981" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec921891" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres949982" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec921890" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Method" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Axillary Lymph Node Dissection in Patients Without Lymph Node Involvement (N0)" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Axillary Lymph Node Dissection in Patients With Sentinel Lymph Node Involvement" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Axillary Radiotherapy in Patients With Lymph Node Involvement (N1–N3)" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Axillary Radiotherapy in Patients Without Clinical Lymph Node Involvement (cN0)" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Axillary Radiation Therapy as an Alternative to Axillary Lymph Node Dissection in Patients With Metastatic Sentinel Lymph Node" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Internal Mammary Chain Radiotherapy" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflict of Interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-04" "fechaAceptado" => "2017-08-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec921891" "palabras" => array:5 [ 0 => "Micrometastases" 1 => "Macrometastases" 2 => "Axillary lymph node dissection" 3 => "Axillary radiotherapy" 4 => "Axillary treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec921890" "palabras" => array:5 [ 0 => "Micrometástasis" 1 => "Macrometástasis" 2 => "Linfadenectomía axilar" 3 => "Radioterapia axilar" 4 => "Tratamiento axilar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Sentinel lymph node biopsy and ACOSOG-Z0011 criteria have modified axillary treatment in breast cancer surgery. We performed a systematic review of studies assessing the impact of axillary treatment on survival. The search showed 6891 potentially eligible items. Of them, 23 clinical trials and 12 meta-analyses published between 1980 and 2017 met the study criteria. The review revealed that axillary lymph node dissection (ALND) can be omitted in patients pN0 and pN1mic, without compromising survival. In patients pN1 it is proposed not to treat the axilla or replace ALND for axillary radiotherapy. The main limitations of this study are the inclusion of old tests that do not use therapeutic targets and lack of risk categorization of relapse. In conclusion, axillary treatment can be avoided in patients without metastatic involvement or micrometastases in the sentinel lymph node. However, there is no evidence to make a recommendation of axillary treatment in N1 patients, so individualized analysis of patient risk factors is needed.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La biopsia de ganglio centinela (BGC) y los criterios ACOSOG-Z0011 han modificado el tratamiento axilar en la cirugía primaria del cáncer de mama. Por esto se realiza una revisión sistemática de los estudios que valoran el impacto del tratamiento axilar en la supervivencia. La búsqueda mostró 6.891 artículos potencialmente elegibles, de los cuales, 23 ensayos clínicos y 12 metaanálisis publicados entre 1980 y 2017 cumplieron los criterios del estudio. La revisión desveló que la linfadenectomía axilar (LA) puede ser omitida en pacientes pN0 y pN1mic, sin comprometer la supervivencia. En pacientes pN1, se propone no tratar la axila o sustituir la LA por radioterapia axilar (RA). Las principales limitaciones de este estudio es que los ensayos son antiguos, no utilizan terapias dianas ni categorizan el riesgo de recaída. En conclusión, el tratamiento axilar puede ser suprimido en pacientes sin afectación metastásica o con micrometástasis del ganglio centinela. No obstante, no hay evidencia para establecer una recomendación de tratamiento axilar en las pacientes con afectación ganglionar N1, por lo que precisan de un análisis individualizado de sus factores de riesgo.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: García Novoa A, Acea Nebril B. Estado actual del tratamiento de la axila en la cirugía primaria del cáncer de mama: revisión sistemática de su impacto en la supervivencia. Cir Esp. 2017;95:503–512.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2050 "Ancho" => 2196 "Tamanyo" => 174813 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Flowchart for the selection of the studies included.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">y: years; RCT: randomized clinical trial; FN: false negative; m: months; MC: multicenter; IM: internal mammary; LE: level of evidence; ART: axillary radiotherapy; OS: overall survival.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical trial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Study type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LE \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical stage \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No. of patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Lymph node involvement \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment evaluated \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Axillary recurrence in % \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Residual axillary dis., % \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OS \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"><span class="elsevierStyleItalic">Clinical N0 (cN0)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NSABP B-04<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I and II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1665 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 and cN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N0: ALND vs ART vs follow-up; N1: ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Johansen<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I, II and III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">666 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 and N1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cabanes<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">658 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Louis-Sylvestre<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">658 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 vs 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">180 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Borgstrom<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">19</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I and II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">195 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND + ART vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Agresti<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">18</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">565 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">127 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Martelli<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">219 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.8 vs 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IBCSG 10-93<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">473 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.6 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Zurrida<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">40</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">435 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"><span class="elsevierStyleItalic">Pathological N0 (pN0)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Milan Trial<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">20</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">516 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 m/10 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NSABP 32<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">21</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5536 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95.6 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GIVOM Trial<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">697 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inconclusive<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"><span class="elsevierStyleItalic">Pathological N1 (pN1mic and pN1)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACOSOG Z0011<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IB and IIA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">891 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.8 vs 3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.3 y/10 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AATRM 048/13/2000<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">233 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN1mic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 vs 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IBCSG 23-01<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">934 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN1mic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 vs 0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AMAROS<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">14</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1425 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5 vs 0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.1 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>OTOASOR<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I and II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1054 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 vs 1.7 (NS) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 m; 8 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="11" align="left" valign="top"><span class="elsevierStyleItalic">Lymph node involvement N1–N3</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ragaz<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">36</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">II, III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">318 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N1, N2, N3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 vs 12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Close to significance<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DBCG 82<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">35</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">II, III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3083 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N1, N2, N3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 vs 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">114 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ragaz<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">37</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">II, III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">318 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N1, N2, N3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 vs 12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MA.20<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">42</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I, II, III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1832 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN0, pN1, pN2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART + IM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 vs 0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.5 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hennequin<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">44</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I, II and III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1334 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N1, N2, N3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART + IM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No differences \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Poortmans<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">43</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT, MC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">I, II, III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N0, N1, N2, N3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART + IM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9 vs 1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.9 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1608645.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">FN: 16.7%.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">P</span>=.05.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">RR: 0.67; <span class="elsevierStyleItalic">P</span>=.008.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical Trials That Analyze the Impact of Axillary Treatment (ALND and ART) on Overall Survival.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">SLNB: sentinel lymph node biopsy; RCT: randomized clinical trial; OS: observational studies; ALND: axillary lymph node dissection; NRP: non-randomized prospective study; ART: axillary radiotherapy; OS: overall survival.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients included \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment evaluated \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Studies included \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Axillary recurrence \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Impact on OS \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Clinical N0 (cN0)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Orr<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1999 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 RCT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits 5.4% (4%–16%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sanghani<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">23</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up; ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Martelli, IBSCG 10-93, Louis-Sylvestre, Veronesi/Zurrida \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OR: 0.27; OR: 0.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rao<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">24</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0, cN+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 studies, Systematic review: RCT and PNR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Similar (1 vs 3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits in cN0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bromham<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">26</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND; ALND vs follow-up; ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 RCT (ALMANAC, GIVOM, NSABP B-32, Veronesi, Canvese) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Similar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Zhang<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">41</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NSABP 04, Louis-Sylvestre, OTOASOR, AMAROS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No differences \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Lymph node involvement N1 (pN1mic and pN1)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glechner<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">29</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Z0011, IBCSG 23-01, AATRM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Similar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ram<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">31</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Z0011, IBSCG 23-01, AATRM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Li<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">30</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0/pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RCT (Z0011, IBSCG 23-01, AATRM), 7 OS (Wang, Park, Yi, Crawford, Yi, Bilimoria, Langer) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS (<span class="elsevierStyleItalic">P</span>=.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits (<span class="elsevierStyleItalic">P</span>=.35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Joyce<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">34</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0/pN0–pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 RCT (Z0011, AATRM, Louis-Sylvestre, IBCSG 10-93, Canavese, GIVOM, Martelli, NSABP B-32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Less in ALND (OR: 225) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits (OR: 1.22; <span class="elsevierStyleItalic">P</span>=.02) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Schmidt-Hansen<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">32</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND; ALND vs ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Z0011, IBSCG 23-01, AATRM, AMAROS, OTOASOR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not significant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Huang<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">33</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 RCT (Z0011, IBSCG 23-01, AATRM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Headon<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">39</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mastectomy+pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 studies (Ragaz, DBCG 82…) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reduces recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Lymph node involvement N0–N3</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>McGale<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">38</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">pN0, N1, N2 and N3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 clinical trials \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Budach<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">45</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N0, N1, N2 and N3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">MA.20, Poortmans, Hennequin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Benefits (<span class="elsevierStyleItalic">P</span>=.03); greater benefits for pN0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1608647.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Meta-Analyses Studying the Impact of Axillary Treatment (ART or ALND).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lymph node involvement</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Level of evidence \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Recommendation grade \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Studies supporting the recommendation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">pN0</td><td class="td" title="table-entry " align="left" valign="top">Observation, follow-up, no radiotherapy or axillary lymph node dissection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Milán,<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">20</span></a> NSABP B32,<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">21</span></a> GIVOM<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">22</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">pN1</td><td class="td" title="table-entry " align="left" valign="top">pN1mic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Observation, follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IBCSG 23-01,<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">11</span></a> AATRM,<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">12</span></a> ACOSOG-Z0011<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Observation, follow-up or axillary lymph node dissection or axillary radiotherapy<br>Axillary radiotherapy presents a lower rate of lymphedema. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ACOSOG-Z0011<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">13</span></a><br>AMAROS,<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">14</span></a> OTOASOR<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">15</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">pN2-N3</td><td class="td" title="table-entry " align="left" valign="top">Axillary lymph node dissection + axillary radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ragaz,<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">36</span></a> DBCG<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">35</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1608644.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Axillary Treatment Recommendation According to Lymph Node Involvement.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Name of trial \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Year of completion \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up, yrs \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients in study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment being evaluated \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">cN0</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BOOG 2013-08 (<span class="elsevierStyleInterRef" id="intr0005" href="ctgov:NCT02271828">NCT02271828</span>)<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">53</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Netherlands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2027 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative surgery+cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SOUND (<span class="elsevierStyleInterRef" id="intr0010" href="ctgov:NCT02167490">NCT02167490</span>)<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">51</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillary ultrasound vs SLNB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ACS Ultrasound <span class="elsevierStyleInterRef" id="intr0015" href="ctgov:NCT01821768">NCT01821768</span><a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">52</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2020 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Axillary ultrasound vs SLNB \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>INSEMA (<span class="elsevierStyleInterRef" id="intr0020" href="ctgov:NCT02466737">NCT02466737</span>)<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">54</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Germany \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative surgery+cN0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SLNB vs follow-up and ALND vs follow-up in pN1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">pN1</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SENOMIC (<span class="elsevierStyleInterRef" id="intr0025" href="ctgov:NCT02049632">NCT02049632</span>)<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">62</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sweden \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative surgery or mastectomy+pN1mic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BOOG 2013-07 (<span class="elsevierStyleInterRef" id="intr0030" href="ctgov:NCT02112682">NCT02112682</span>)<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">64</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Netherlands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2027 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mastectomy+pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleInterRef" id="intr0035" href="ctgov:NCT01717131">NCT01717131</span><a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">65</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">France \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2025 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative surgery or mastectomy+pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleInterRef" id="intr0040" href="ctgov:NCT02240472">NCT02240472</span><a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">66</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Sweden \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2029 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative surgery or mastectomy+pN1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Axillary radiotherapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>OPTIMAL (<span class="elsevierStyleInterRef" id="intr0045" href="ctgov:NCT02335957">NCT02335957</span>)<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">67</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2022 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative surgery+pN1 sin ALND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ART vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>POSNOC (<span class="elsevierStyleInterRef" id="intr0050" href="ctgov:NCT02401685">NCT02401685</span>)<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">68</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multicenter; UK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Conservative surgery or mastectomy+1 or 2 GC con macrometastasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ALND vs ART vs follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1608646.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical Trials Underway.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:68 [ 0 => array:3 [ "identificador" => "bib0345" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Senkus" 1 => "S. Kyriakides" 2 => "F. Penault-Llorca" 3 => "P. Poortmans" 4 => "A. Thompson" 5 => "S. Zackrisson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Oncol" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "7" "paginaFinal" => "23" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0350" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary breast cancer: ESMO clinical practice guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Senkus" 1 => "S. Kyriakides" 2 => "S. Ohno" 3 => "F. Penault-Llorca" 4 => "P. Poortmans" 5 => "E. Rutger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Oncol" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "8" "paginaFinal" => "30" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0355" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, et al. NCCN Guidelines Breast Cancer. National Comprenhensive Cancer Network. 2014 [accessed 18 Nov 2016]. <a href="https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf">https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf</a>" ] ] ] 3 => array:3 [ "identificador" => "bib0360" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tailoring therapies – improving the management of early breast cancer: St Gallen International Expert Consensus on the primary therapy of early breast cancer 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Coates" 1 => "E.P. Winer" 2 => "A. Goldhirsch" 3 => "R.D. Gelber" 4 => "M. Gnant" 5 => "M. Piccart-Gebhart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/annonc/mdv221" "Revista" => array:6 [ "tituloSerie" => "Ann Oncol" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "1533" "paginaFinal" => "1546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25939896" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0365" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Findings from NSABP Protocol No. B-04: comparison of radical mastectomy with alternative treatments. II. The clinical and biologic significance of medial-central breast cancers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Fisher" 1 => "N. Wolmark" 2 => "C. Redmond" 3 => "M. Deutsch" 4 => "E.R. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1981" "volumen" => "48" "paginaInicial" => "1863" "paginaFinal" => "1872" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7284980" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0370" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simple mastectomy with postoperative irradiation versus extended radical mastectomy in breast cancer. A twenty-five-year follow-up of a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Johansen" 1 => "S. Kaae" 2 => "T. Schiodt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Oncol" "fecha" => "1990" "volumen" => "29" "paginaInicial" => "709" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2223140" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0375" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of axillary dissection in addiction to lumpectomy and radiotherapy in early breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.A. Cabanes" 1 => "R.J. Salmon" 2 => "J.R. Vilcoq" 3 => "J.C. Durand" 4 => "A. Fourquet" 5 => "C. Gautier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1992" "volumen" => "339" "paginaInicial" => "1245" "paginaFinal" => "1248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1349666" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0380" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary treatment in conservative management of operable breast cancer: dissection or radiotherapy? Results of a randomized study with 15 years of follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Louis-Sylvestre" 1 => "K. Clough" 2 => "B. Asselain" 3 => "J.R. Vilcoq" 4 => "R.J. Salmon" 5 => "F. Campana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2004.12.108" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2004" "volumen" => "22" "paginaInicial" => "97" "paginaFinal" => "101" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14701770" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0385" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Martelli" 1 => "P. Boracchi" 2 => "M. de Palo" 3 => "S. Pilotti" 4 => "S. Oriana" 5 => "R. Zucali" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2005" "volumen" => "242" "paginaInicial" => "1" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15973094" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0390" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10-93" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "International Breast Cancer Study Group" "etal" => true "autores" => array:6 [ 0 => "C.M. Rudenstam" 1 => "D. Zahrjeh" 2 => "J.F. Forbes" 3 => "D. Crivellari" 4 => "S.B. Holmberg" 5 => "P. Rey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2005.01.5784" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2006" "volumen" => "24" "paginaInicial" => "337" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16344321" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0395" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "International Breast Cancer Study Group Trial 23-01 investigators" "etal" => true "autores" => array:6 [ 0 => "V. Galimberti" 1 => "B.F. Cole" 2 => "S. Zurrida" 3 => "G. Viale" 4 => "A. Luini" 5 => "P. Veronesi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(13)70035-4" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "297" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23491275" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0400" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Solá" 1 => "J.A. Alberro" 2 => "M. Fraile" 3 => "P. Santesteban" 4 => "M. Ramos" 5 => "R. Fabregas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1245/s10434-012-2569-y" "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2013" "volumen" => "20" "paginaInicial" => "120" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22956062" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0405" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: The American College of Surgeons Oncology Group Z0011 Randomized Trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.E. Giuliano" 1 => "L. McCall" 2 => "P. Beitsch" 3 => "P.W. Whitworth" 4 => "P. Blumencranz" 5 => "A.M. Laitch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e3181f08f32" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2010" "volumen" => "252" "paginaInicial" => "426" "paginaFinal" => "433" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20739842" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0410" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Donker" 1 => "G. van Tienhoven" 2 => "M.E. Straver" 3 => "P. Meijnen" 4 => "C.J. van de Velde" 5 => "R.E. Mansel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(14)70460-7" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "1303" "paginaFinal" => "1310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25439688" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0415" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optimal treatment of the axilla after positive sentinel lymph node biopsy in primary invasive breast cancer: OTOASOR Trial, a randomized, single centre, phase III, non-inferiority trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sávolt" 1 => "Z. Mátrai" 2 => "C. Polgár" 3 => "N. Udvarhelyi" 4 => "E. Kovács" 5 => "B. Gyórffy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "EJSO" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "100" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0420" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "e1000100" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate helath care interventions: explanation and elaboration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Liberti" 1 => "D.G. Altman" 2 => "J. Tetzlaff" 3 => "C. Mulrow" 4 => "P.C. Gotzsche" 5 => "J.P. Ioannidis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "PLoS Med" "fecha" => "2009" "volumen" => "6" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0425" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current methods of the U.S. Preventive Services Task Force: a review of the process" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "For the Methods Work Group, Third U.S. Preventive Services Task Force" "etal" => true "autores" => array:6 [ 0 => "R.P. Harris" 1 => "M. Helfand" 2 => "S.H. Woolf" 3 => "K.N. Lohr" 4 => "C.D. Mulrow" 5 => "S.M. Teutsch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Prev Med" "fecha" => "2001" "volumen" => "20" "numero" => "3S" "paginaInicial" => "21" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11306229" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0430" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary lymph node dissection versus no dissection in patients with T1N0 breast cancer: a randomized clinical trial (INT09/98)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Agresti" 1 => "G. Martelli" 2 => "M. Sandri" 3 => "E. Tagliabue" 4 => "M.L. Carcangiu" 5 => "I. Maugeri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.28499" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2014" "volumen" => "120" "paginaInicial" => "885" "paginaFinal" => "893" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24323615" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0435" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mastectomy only versus radical mastectomy and postoperative radiotherapy in node negative, resectable breast cancer, a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Borgstrom" 1 => "F. Linell" 2 => "L. Tennvall" 3 => "N. Ranstam" 4 => "J. Ranstam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/02841869409083935" "Revista" => array:6 [ "tituloSerie" => "Acta Oncol" "fecha" => "1994" "volumen" => "33" "paginaInicial" => "557" "paginaFinal" => "560" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7917371" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0440" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "U. Veronesi" 1 => "G. Paganelli" 2 => "G. Viale" 3 => "F.R.C. Path" 4 => "A. Luini" 5 => "S. Zurrida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa012782" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "349" "paginaInicial" => "546" "paginaFinal" => "553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12904519" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0445" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.N. Krag" 1 => "S.J. Anderson" 2 => "T.B. Julian" 3 => "A.M. Brown" 4 => "S.P. Harlow" 5 => "T. Ashikaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1470-2045(07)70278-4" "Revista" => array:6 [ "tituloSerie" => "Lancet Oncol" "fecha" => "2007" "volumen" => "8" "paginaInicial" => "881" "paginaFinal" => "888" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17851130" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0450" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized clinical trial on sentinel lymph node biopsy versus axillary lymph node dissection in breast cancer: results of the Sentinella/GIVOM trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Zavagno" 1 => "G.L. De Salvo" 2 => "G. Scalco" 3 => "F. Bozza" 4 => "L. Barutta" 5 => "P. Del Bianco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0b013e31812e6a73" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2008" "volumen" => "247" "paginaInicial" => "207" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18216523" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0455" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of axillary lymph node dissection on breast cancer outcome in clinically node negative patients: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Sanghani" 1 => "E.M. Balk" 2 => "B. Cady" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.24174" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2009" "volumen" => "115" "paginaInicial" => "1613" "paginaFinal" => "1620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19199349" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0460" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary node interventions in breast cancer. A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Rao" 1 => "D. Euhus" 2 => "H.G. Mayo" 3 => "C. Balch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2013.277804" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "310" "paginaInicial" => "1385" "paginaFinal" => "1394" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24084924" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0465" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of prophylactic axillary node dissection on breast cancer survival: a Bayesian meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.K. Orr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "1999" "volumen" => "6" "paginaInicial" => "17" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10030410" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0470" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "CD004561" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary treatment for operable primary breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Bromham" 1 => "M. Schmidt-Hansen" 2 => "M. Astin" 3 => "E. Hasler" 4 => "M.W. Reed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD004561.pub3" "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "Jan 4 2017" "volumen" => "1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22259004" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0475" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.E. Giuliano" 1 => "K. Ballman" 2 => "L. McCall" 3 => "P. Beitsch" 4 => "P.W. Whitworth" 5 => "P. Blumencranz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SLA.0000000000001863" "Revista" => array:6 [ "tituloSerie" => "Ann Surg" "fecha" => "2016" "volumen" => "264" "paginaInicial" => "413" "paginaFinal" => "420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27513155" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0480" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiation field design in the ACOSOG Z0011 (Alliance) trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Jagsi" 1 => "M. Chadha" 2 => "J. Moni" 3 => "K. Ballman" 4 => "F. Laurie" 5 => "T.A. Buchholz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2014.56.5838" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "3600" "paginaFinal" => "3606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25135994" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0485" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel lymph node dissection only versus complete axillary lymph node dissection in early invasive breast cancer: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Glechner" 1 => "A. Wöckel" 2 => "G. Gartlehner" 3 => "K. Thaler" 4 => "M. Strobelberger" 5 => "U. Griebler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejca.2012.09.010" "Revista" => array:6 [ "tituloSerie" => "Eur J Cancer" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "812" "paginaFinal" => "825" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23084155" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0490" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary lymph node dissection versus sentinel lymph node biopsy alone for early breast cancer with sentinel node metastasis: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.Z. Li" 1 => "P. Zhang" 2 => "R.W. Li" 3 => "C.T. Wu" 4 => "X.P. Zhang" 5 => "H.C. Zhu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejso.2015.05.007" "Revista" => array:6 [ "tituloSerie" => "EJSO" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "958" "paginaFinal" => "966" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26054706" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0495" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[accessed 15 Sep 2016]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel node biopsy alone versus completion axillary node dissection in node positive breast cancer: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Ram" 1 => "J. Singh" 2 => "E. McCaig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2014/513780" "Revista" => array:2 [ "tituloSerie" => "Int J Breast Cancer" "fecha" => "2014" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0500" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary surgery in women with sentinel node-positive operable breast cancer: a systematic review with meta-analyses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Schmidt-Hansen" 1 => "N. Bromham" 2 => "E. Hasler" 3 => "M.W. Reed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40064-016-1712-9" "Revista" => array:5 [ "tituloSerie" => "Springer Plus" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26848425" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0505" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendation for axillary lymph node dissection in women with early breast cancer and sentinel node metastasis: a systematic review and meta-analysis of randomized controlled trials using the GRADE system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.W. Huang" 1 => "K.N. Kuo" 2 => "K.H. Chen" 3 => "C. Chen" 4 => "W.H. Hou" 5 => "W.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijsu.2016.08.022" "Revista" => array:6 [ "tituloSerie" => "Int J Surg" "fecha" => "2016" "volumen" => "34" "paginaInicial" => "73" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27562691" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0510" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis to determine the clinical impact of axillary lymph node dissection in the treatment of invasive breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.P. Joyce" 1 => "A. Manning" 2 => "M. Carter" 3 => "A.D. Hill" 4 => "M.R. Kell" 5 => "M. Barry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10549-015-3549-2" "Revista" => array:6 [ "tituloSerie" => "Breast Cancer Res Treat" "fecha" => "2015" "volumen" => "153" "paginaInicial" => "235" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26283300" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0515" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "The Danish Breast Cancer Cooperative Group 82b Trial" "etal" => true "autores" => array:6 [ 0 => "M. Overgaard" 1 => "P. Hansen" 2 => "J. Overgaard" 3 => "C. Rose" 4 => "M. Anderson" 5 => "F. Bach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199710023371401" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1997" "volumen" => "337" "paginaInicial" => "949" "paginaFinal" => "955" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9395428" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0520" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adjuvant radiotherapy and chemotherapy in node-positive premenopausal woman with breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Ragaz" 1 => "S. Jackson" 2 => "N. Le" 3 => "I. Plenderleith" 4 => "J. Spinelli" 5 => "V. Basco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199710023371402" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1997" "volumen" => "337" "paginaInicial" => "956" "paginaFinal" => "962" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9309100" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0525" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Ragaz" 1 => "I.A. Olivotto" 2 => "J.J. Spinelli" 3 => "N. Phillips" 4 => "S.M. Jackson" 5 => "K.S. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/jnci/djh297" "Revista" => array:6 [ "tituloSerie" => "J Natl Cancer Inst" "fecha" => "2005" "volumen" => "97" "paginaInicial" => "116" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15657341" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0530" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EBCTCG (Early Breast Cancer Trialists’ Collaborative Group)" "etal" => true "autores" => array:6 [ 0 => "P. McGale" 1 => "C. Taylor" 2 => "C. Correa" 3 => "D. Cutter" 4 => "F. Duane" 5 => "M. Ewertz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)60488-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "383" "paginaInicial" => "2127" "paginaFinal" => "2135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24656685" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0535" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement of survival with postmastectomy radiotherapy in patients with 1–3 positive axillary lymph nodes: a systematic review and meta-analysis of the current literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Headon" 1 => "A. Kasem" 2 => "R. Almukbel" 3 => "K. Mokbel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3892/mco.2016.971" "Revista" => array:6 [ "tituloSerie" => "Mol Clin Oncol" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "429" "paginaFinal" => "436" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27699038" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0540" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary radiotherapy instead of axillary dissection: a randomized trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Italian Oncological Senology Group" "etal" => true "autores" => array:6 [ 0 => "S. Zurrida" 1 => "R. Orecchia" 2 => "V. Galimberti" 3 => "A. Luini" 4 => "I. Giannetti" 5 => "B. Ballardini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2002" "volumen" => "9" "paginaInicial" => "156" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11888872" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0545" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Zhang" 1 => "C. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/srep26304" "Revista" => array:5 [ "tituloSerie" => "Sci Rep" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "26304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27212421" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0550" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "(Ma.20). Regional nodal irradiation in early-stage breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.J. Whelan" 1 => "I.A. Olivotto" 2 => "W.R. Parulekar" 3 => "I. Ackerman" 4 => "B.H. Chua" 5 => "A. Nabid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1415340" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "307" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26200977" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0555" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Internal mammary and medial supraclavicular irradiation in breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.M. Poortmans" 1 => "S. Collette" 2 => "C. Kirkove" 3 => "E. van Linbergen" 4 => "V. Budach" 5 => "H. Struikmans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1415369" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "373" "paginaInicial" => "317" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26200978" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0560" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Hennequin" 1 => "N. Bossard" 2 => "S. Servagi-Vernat" 3 => "P. Maingon" 4 => "J.B. Dubois" 5 => "J. Datchary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijrobp.2013.03.021" "Revista" => array:6 [ "tituloSerie" => "Int J Radiat Oncol Biol Phys" "fecha" => "2013" "volumen" => "86" "paginaInicial" => "860" "paginaFinal" => "866" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23664327" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0565" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adjuvant radiation therapy of regional lymph node in breast cancer – a meta-analysis of randomized trials. An update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. Budach" 1 => "E. Bolke" 2 => "K. Kammers" 3 => "P. Arne Gerber" 4 => "C. Nestle-Krämling" 5 => "C. Matuschek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Rad Oncol" "fecha" => "2015" "volumen" => "10" "paginaInicial" => "258" ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0570" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Fisher" 1 => "C. Redmond" 2 => "E.R. Fisher" 3 => "M. Bauer" 4 => "N. Wolmark" 5 => "Wickerham Dl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198503143121102" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1985" "volumen" => "312" "paginaInicial" => "674" "paginaFinal" => "681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3883168" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0575" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manchester regional breast study – 5 and 10 year results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.P. Lythgoe" 1 => "M.K. Palmer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "1982" "volumen" => "69" "paginaInicial" => "693" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7171967" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0580" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Christie Hospital breast conservations trial: an update at 8 years from inception" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G.G. Ribeiro" 1 => "B. Magee" 2 => "R. Swindell" 3 => "M. Harris" 4 => "S.S. Banerjee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Oncol" "fecha" => "1993" "volumen" => "5" "paginaInicial" => "278" "paginaFinal" => "283" ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0585" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcome following breast conserving surgery and radiation therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Gage" 1 => "A. Recht" 2 => "R. Gelman" 3 => "A.J. Nixon" 4 => "B. Silver" 5 => "B.A. Bornstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0360-3016(95)02001-R" "Revista" => array:6 [ "tituloSerie" => "Int J Radiat Oncol Biol Phys" "fecha" => "1995" "volumen" => "33" "paginaInicial" => "245" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7673011" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0590" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tailoring therapies – improving the management of early breast cancer: St. Gallen International Expert Consensus on the primary therapy of early breast cancer 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Coates" 1 => "E.P. Winer" 2 => "A. Goldhirsch" 3 => "R.D. Gelber" 4 => "M. Gnant" 5 => "M. Piccart-Gebhart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/annonc/mdv221" "Revista" => array:6 [ "tituloSerie" => "Ann Oncol" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "1533" "paginaFinal" => "1546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25939896" "web" => "Medline" ] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0595" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[accessed 5 Nov 2016]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abandoning sentinel lymph node biopsy in early breast cancer? A new trial in progress at the European Institute of Oncology of Milan (SOUND: sentinel node vs observation after axillary UltraSouND)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "O. Gentilini" 1 => "U. Veronesi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.breast.2012.06.013" "Revista" => array:6 [ "tituloSerie" => "Breast" "fecha" => "2012" "volumen" => "21" "paginaInicial" => "678" "paginaFinal" => "681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22835916" "web" => "Medline" ] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0600" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[accessed 5 Nov 2016] Available in: <span class="elsevierStyleInterRef" id="intr0070" href="https://clinicaltrials.gov/show/NCT01821768">https://clinicaltrials.gov/show/NCT01821768</span>" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful completion of the pilot phase of a randomized controlled trial comparing sentinel lymph node biopsy to no further axillary staging in patients with clinical T1-T2 N0 breast cancer and normal axillary ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Cyr" 1 => "N. Tucker" 2 => "F. Ademuyiwa" 3 => "J.A. Margenthaler" 4 => "R.L. Aft" 5 => "T.J. Eberlein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Col Surg" "fecha" => "2016" "volumen" => "223" "paginaInicial" => "399" "paginaFinal" => "407" ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0605" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Smidt ML. BOOG 2013-08: Clinically node negative breast cancer patients undergoing breast conserving therapy: Sentinel lymph node procedure versus follow-up [accessed 5 Nov 2016]. Available in: <a href="https://www.boogstudycenter.nl/studie/273/2013-08-lumpectomie.html">https://www.boogstudycenter.nl/studie/273/2013-08-lumpectomie.html</a>" ] ] ] 53 => array:3 [ "identificador" => "bib0610" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Reimer T. Comparison of axillary sentinel lymph node biopsy versus no axillary surgery in patients with early-stage invasive breast cancer and breast-conserving surgery: a randomized prospective surgical trial. Intergroup-Sentinel-Mamma (INSEMA)-Trial [accessed 5 Nov 2016]. Available in: <a href="https://clinicaltrials.gov/ct2/show/NCT02466737">https://clinicaltrials.gov/ct2/show/NCT02466737</a>" ] ] ] 54 => array:3 [ "identificador" => "bib0615" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of sentinel lymph node biopsy alone and completion axillary lymph node dissection for node-positive breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.Y. Bilimoria" 1 => "D.J. Bentrem" 2 => "N.M. Hansen" 3 => "K.P. Bethke" 4 => "A.W. Rademaker" 5 => "C.Y. Ko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2008.19.5750" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "2946" "paginaFinal" => "2953" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19364968" "web" => "Medline" ] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0620" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Yi" 1 => "S.H. Giordano" 2 => "F. Meric-Bernstam" 3 => "E.A. Mittendorf" 4 => "H.M. Kuerer" 5 => "R.F. Hwang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1245/s10434-010-1253-3" "Revista" => array:7 [ "tituloSerie" => "Ann Surg Oncol" "fecha" => "2010" "volumen" => "17" "numero" => "Suppl. 3" "paginaInicial" => "343" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20853057" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0625" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic value of isolated tumor cells and micrometastases of lymph nodes in early-stage breast cancer: a French sentinel node multicenter cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Houvenaeghel" 1 => "J.M. Classe" 2 => "J.R. Garbay" 3 => "S. Giard" 4 => "M. Cohen" 5 => "C. Faure" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.breast.2014.04.004" "Revista" => array:6 [ "tituloSerie" => "Breast" "fecha" => "2014" "volumen" => "23" "paginaInicial" => "561" "paginaFinal" => "566" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24874284" "web" => "Medline" ] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0630" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel node micrometastases in breast cancer do not affect prognosis: a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.J. Maaskant-Braat" 1 => "L.V. van de Poll-Franse" 2 => "A.C. Voogd" 3 => "J.W. Coebergh" 4 => "R.M. Roumen" 5 => "M.C. Nolthenius-Puylaert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10549-010-1086-6" "Revista" => array:6 [ "tituloSerie" => "Breast Cancer Res Treat" "fecha" => "2011" "volumen" => "127" "paginaInicial" => "195" "paginaFinal" => "203" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20680679" "web" => "Medline" ] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0635" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of micrometastases in the sentinel node of patients with invasive breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.M. Hansen" 1 => "B. Grube" 2 => "X. Ye" 3 => "R.R. Turner" 4 => "R.J. Brenner" 5 => "M.S. Sim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2008.19.0686" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2009" "volumen" => "27" "paginaInicial" => "4679" "paginaFinal" => "4684" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19720928" "web" => "Medline" ] ] ] ] ] ] ] ] 59 => array:3 [ "identificador" => "bib0640" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.A. Minttendorf" 1 => "K.V. Ballman" 2 => "L.M. McCall" 3 => "M. Yi" 4 => "A.A. Sahin" 5 => "I. Bedrosian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1200/JCO.2014.57.2958" "Revista" => array:6 [ "tituloSerie" => "J Clin Oncol" "fecha" => "2015" "volumen" => "33" "paginaInicial" => "1119" "paginaFinal" => "1127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25488970" "web" => "Medline" ] ] ] ] ] ] ] ] 60 => array:3 [ "identificador" => "bib0645" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of occult metastases in sentinel lymph nodes and bone marrow with survival among women with early-stage invasive breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.E. Giuliano" 1 => "D. Hawes" 2 => "K.V. Ballman" 3 => "P.W. Whitworth" 4 => "P.W. Blumencranz" 5 => "D.S. Reintgen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2011.1034" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2011" "volumen" => "306" "paginaInicial" => "385" "paginaFinal" => "393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21791687" "web" => "Medline" ] ] ] ] ] ] ] ] 61 => array:3 [ "identificador" => "bib0650" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Boniface J. Survival and axillary relapse in breast cancer patients with sentinel node micrometastases who have not undergone completion axillary clearance – a national cohort study [accessed 5 Nov 2016]. Available in: <a href="https://clinicaltrials.gov/ct2/show/NCT02049632?term=senomic%26rank=1">https://clinicaltrials.gov/ct2/show/NCT02049632?term=senomic&rank=1</a>" ] ] ] 62 => array:3 [ "identificador" => "bib0655" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radioterapia axilar en la cirugía conservadora del cáncer de mama en estadio temprano (estadios I y II)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. García Novoa" 1 => "B. Acea Nebril" 2 => "I. Díaz" 3 => "S. Builes Ramírez" 4 => "C. Varela" 5 => "C. Cereijo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ciresp.2016.04.003" "Revista" => array:6 [ "tituloSerie" => "Cir Esp" "fecha" => "2016" "volumen" => "94" "paginaInicial" => "331" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27256280" "web" => "Medline" ] ] ] ] ] ] ] ] 63 => array:3 [ "identificador" => "bib0660" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of completion axillary treatment in sentinel node positive breast cancer patients undergoing a mastectomy: a Dutch randomized controlled multicentre trial (BOOG 2013-07)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.M. Van Roozendaal" 1 => "J.H.W. de Wilt" 2 => "T. van Dalen" 3 => "J.A. van der Hage" 4 => "L.J.A. Strobbe" 5 => "L.J. Boersma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12885-015-1613-2" "Revista" => array:5 [ "tituloSerie" => "BMC Cancer" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "610" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26335105" "web" => "Medline" ] ] ] ] ] ] ] ] 64 => array:3 [ "identificador" => "bib0665" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Houvenaeghel G. A non inferiority randomized multicenter phase III trial of axillary node dissection versus no axillary node dissection in case of positive sentinel lymph node in invasive breast cancer [accessed 5 Nov 2016]. Available in: <a href="https://clinicaltrials.gov/ct2/show/NCT01717131">https://clinicaltrials.gov/ct2/show/NCT01717131</a>" ] ] ] 65 => array:3 [ "identificador" => "bib0670" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Boniface J. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection – a randomized study of patients with macrometastases in the sentinel node [accessed 5 Nov 2016]. Available in: <a href="https://clinicaltrials.gov/ct2/show/NCT02240472">https://clinicaltrials.gov/ct2/show/NCT02240472</a>" ] ] ] 66 => array:3 [ "identificador" => "bib0675" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Algara M. OPTimizing Irradiation Through Molecular Assessment of Lymph Node (OPTIMAL) [accessed 5 Nov 2016]. Available in: <a href="https://clinicaltrials.gov/ct2/show/NCT02335957">https://clinicaltrials.gov/ct2/show/NCT02335957</a>" ] ] ] 67 => array:3 [ "identificador" => "bib0680" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "POSNOC: a randomised trial looking at axillary treatment in women with one or two sentinel nodes with macrometastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Goyal" 1 => "D. Dodwell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Oncol" "fecha" => "2015" "volumen" => "27" "paginaInicial" => "692" "paginaFinal" => "695" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009500000009/v1_201712020521/S217350771730193X/v1_201712020521/en/main.assets" "Apartado" => array:4 [ "identificador" => "71160" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009500000009/v1_201712020521/S217350771730193X/v1_201712020521/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217350771730193X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 1 | 10 |
| 2024 October | 47 | 4 | 51 |
| 2024 September | 49 | 4 | 53 |
| 2024 August | 38 | 3 | 41 |
| 2024 July | 40 | 6 | 46 |
| 2024 June | 46 | 0 | 46 |
| 2024 May | 33 | 5 | 38 |
| 2024 April | 34 | 10 | 44 |
| 2024 March | 59 | 7 | 66 |
| 2024 February | 40 | 7 | 47 |
| 2024 January | 45 | 10 | 55 |
| 2023 December | 35 | 13 | 48 |
| 2023 November | 35 | 7 | 42 |
| 2023 October | 51 | 19 | 70 |
| 2023 September | 16 | 4 | 20 |
| 2023 August | 32 | 2 | 34 |
| 2023 July | 18 | 7 | 25 |
| 2023 June | 18 | 5 | 23 |
| 2023 May | 41 | 5 | 46 |
| 2023 April | 50 | 1 | 51 |
| 2023 March | 50 | 4 | 54 |
| 2023 February | 24 | 11 | 35 |
| 2023 January | 37 | 5 | 42 |
| 2022 December | 29 | 4 | 33 |
| 2022 November | 45 | 10 | 55 |
| 2022 October | 34 | 11 | 45 |
| 2022 September | 122 | 9 | 131 |
| 2022 August | 52 | 8 | 60 |
| 2022 July | 34 | 13 | 47 |
| 2022 June | 35 | 9 | 44 |
| 2022 May | 32 | 7 | 39 |
| 2022 April | 57 | 8 | 65 |
| 2022 March | 59 | 11 | 70 |
| 2022 February | 94 | 7 | 101 |
| 2022 January | 100 | 7 | 107 |
| 2021 December | 86 | 10 | 96 |
| 2021 November | 54 | 17 | 71 |
| 2021 October | 74 | 27 | 101 |
| 2021 September | 43 | 14 | 57 |
| 2021 August | 36 | 13 | 49 |
| 2021 July | 44 | 11 | 55 |
| 2021 June | 38 | 14 | 52 |
| 2021 May | 68 | 15 | 83 |
| 2021 April | 176 | 23 | 199 |
| 2021 March | 97 | 14 | 111 |
| 2021 February | 73 | 22 | 95 |
| 2021 January | 67 | 15 | 82 |
| 2020 December | 63 | 23 | 86 |
| 2020 November | 68 | 11 | 79 |
| 2020 October | 49 | 11 | 60 |
| 2020 September | 47 | 14 | 61 |
| 2020 August | 51 | 7 | 58 |
| 2020 July | 64 | 16 | 80 |
| 2020 June | 52 | 10 | 62 |
| 2020 May | 93 | 28 | 121 |
| 2020 April | 41 | 3 | 44 |
| 2020 March | 47 | 5 | 52 |
| 2020 February | 41 | 5 | 46 |
| 2020 January | 48 | 12 | 60 |
| 2019 December | 55 | 15 | 70 |
| 2019 November | 29 | 14 | 43 |
| 2019 October | 44 | 14 | 58 |
| 2019 September | 29 | 12 | 41 |
| 2019 August | 15 | 2 | 17 |
| 2019 July | 33 | 9 | 42 |
| 2019 June | 36 | 10 | 46 |
| 2019 May | 88 | 14 | 102 |
| 2019 April | 58 | 8 | 66 |
| 2019 March | 31 | 10 | 41 |
| 2019 February | 31 | 4 | 35 |
| 2019 January | 8 | 2 | 10 |
| 2018 December | 12 | 2 | 14 |
| 2018 November | 25 | 8 | 33 |
| 2018 October | 25 | 8 | 33 |
| 2018 September | 39 | 3 | 42 |
| 2018 August | 9 | 0 | 9 |
| 2018 July | 5 | 3 | 8 |
| 2018 June | 10 | 2 | 12 |
| 2018 May | 6 | 7 | 13 |
| 2018 April | 9 | 5 | 14 |
| 2018 March | 12 | 0 | 12 |
| 2018 February | 3 | 0 | 3 |
| 2018 January | 1 | 0 | 1 |
| 2017 November | 1 | 4 | 5 |
Show all
